Nonprofit grows budget 500% in four years — to $157 million

CAN Community Health officials say growth follows demand.

Sarasota executive Rick Carlisle is an admitted to-do list aficionado, and that could be an asset as he tackles the next phase of his organization’s ambitious growth strategy.

EXECUTIVE SUMMARY

Organization. CAN Community Health

Industry. health care, nonprofit

Trend. Organziation manages rapid growth.

The list of things to do at the HIV and AIDS medical services organization Carlisle helms, Sarasota-based CAN Community Health, is telephone pole long. That’s mostly because CAN, a nonprofit, is amid an unprecedented growth spurt for roughly any entity, anywhere — for-profit or 501(c)3.

The funding behind the surge comes almost exclusively from a complicated federal program called 340B, which CAN has honed over the past three years. For CAN, 340B provides the fuel to chase its mission: to care for one of the country’s most under-cared for demographics.

“I told my executive team soon after I took this job,” in April 2015, says Carlisle, “that we have an opportunity to save a lot more people. Our job is to find them and get them into treatment.”

The Rev. Demetrius Jifunza, chairman of CAN’s Strategic Planning Committee and a Sarasota-area civil rights activist, paralegal and pastor, has helped Carlisle execute the mission. “A lot of our growth is answering the wants and needs of the community,” says Jifunza.

There’s an internal tug for the to-do list, too, in maintaining and improving upon CAN’s reputation as a top place nationally to work. The organization, for example, ranked No. 5 in The Nonprofit Times Best Nonprofits to work For 2018 list, one of several such accolades. Says Carlisle: “People just love working here.”

Some of the standout growth points at CAN, which also does HIV and AIDS research and provides an array of medical and health care services for people with sexually transmitted diseases and hepatitis C, include:

The operating budget has grown 528% since 2015, from $25.5 million to a projected $157 million in fiscal 2018-2019;

The population the organization provides treatment for has grown nearly fourfold since 2015, from 4,000 to 15,000 people;

Locations it operates or partners with other providers on have grown from 10 in 2015 to 30 in 2018, with 10 more planned for the 2018-2019 fiscal year. Its footprint is mostly in Florida, from Jacksonville to Miami to the west coast, with one location in Columbia, S.C. Future clinics include two planned for Puerto Rico.

The payroll has grown from 34 people in 2015 to 200 today, and Carlisle expects to add 100 more employees over the next year;

By the numbers: CAN Community Health

Year Revenue/Fiscal operating budget % growth

2015 $25.53 million

2016 $39.93 million 56.4%

2017 $92.52 million 131.7%

2018 $124 million 34%

2019 $157 million (projected)

Source: GuideStar, The Giving Partner, CAN Community Health

CAN bought a new building in May, a 23,000-square-foot property on Fruitville Road, about halfway between downtown Sarasota and Interstate 75. The organization paid $4.8 million for the property and 3 acres surrounding it, and will begin consolidating its three facilities into the one space later this year;

Last year, it bought an eight-seat King Air private plane for $2 million, to get its people to its far-flung locations faster.

“That’s a big asset for us,” says CAN board chairman Bob Trisolini, who has been active with the organization for nearly two decades, going back to when it was a two-room clinic near the courthouse in downtown Sarasota in the late 1990s. “We can hold meetings now and get people back and forth in the same day.”

Big believer

The glue that holds the growth at CAN together, say Trisolini and Jifunza, is Carlisle. Trisolini, who worked on Broadway in casting and producing, among other areas, says Carlisle’s ability to find talent in people and hire top-notch executives is a key asset. Jifunza adds Carlisle provides a calming influence around the chaos of fast growth. “He has a way of putting things together that just makes sense,” Jifunza says. “CAN wouldn’t be where it is without him.”

A onetime Sarasota Memorial Hospital executive who also ran his own construction firm, Carlisle befriended CAN’s co-founder, Susan Terry. They bonded over the mission of the organization, called the Community AIDS Network, when Terry and Dr. Jeffrey Stahl founded it in 1991. (The organization rebranded under CAN in 2017.)

"We have an opportunity to save a lot more people. Our job is to find them and get them into treatment." Rick Carlisle

Terry died in 2009 at 53 years old, and Carlisle went from informal adviser to CAN board member. The board asked Carlisle to become CEO in early 2015.

“I was actually looking to open another construction company,” says Carlisle, with a degree in building science from Auburn University. “But I really believed in this group and its mission. There is no other job or organization like this.”

Carlisle says his biggest internal challenge now — not unlike for-profit firms — is to find and hire top people to manage the rapid growth. One of his go-to hiring techniques is to have all the executives participate in the interview process early on, even if the candidate won’t report to them. “We want to assure teamwork as early on as possible,” says Carlisle.

‘Stretch Resources’

CAN targets its mission by tracking local, state and federal health department data of HIV and AIDS cases by ZIP code. Carlisle, the to-do list taskmaster, keeps a PDF of an HIV and AIDS tracking map on his computer, which doubles as an expansion projection sheet. In some cases, CAN goes into an area and partners with an existing social services group that works with the HIV and AIDS population. Other times CAN opens its own clinics.

The drive behind the explosive growth, meanwhile, is a twofold play on supply and demand. The demand for HIV and AIDS health care treatment, particularly in Florida and the Southeast, says Carlisle, is rapidly on the rise. Many would-be patients go under-treated or not treated at all given the societal stigma. “A lot of people would just assume to forget about them,” says Carlisle.

At a glance: CAN Community Health

• President and CEO: Rick Carlisle

• Year founded: 1991

• 2018 fiscal operating budget: $124 million

• Employees: 200

• Program ratio: 92%. That means 92 cents from every dollar in 2017 went to program services; the national average in CAN’s peer group in 87%.

• Programs per employee: $670,000 in 2017. National average in CAN’s peer group ranges from $250 to $580,000 per employee.

Source: CAN 2017 audit, GuideStar

CAN can fill the demand because of 340B — the complicated and somewhat controversial federal drug-pricing program. Under 340B, pharmaceutical companies sign an agreement with the government to provide discounts of at least 50% on medications to pre-approved agencies and health care providers, like CAN. Those agencies, to qualify for 340B, need to have the total funds to pay for the drugs — money that comes from reimbursements, grants and community donations. A third-party administrator holds those funds.

In turn, CAN is required to use the savings and money it didn’t spend on drugs — millions of dollars — to provide more services to current and new patients. Based on the wording of the 1992 law that created 340B, this allows groups like CAN to “stretch scarce federal resources as far as possible” without straight-up using taxpayer funds.

“The program was designed to provide deep discounts to low-income health care providers,” says Scott Ponaman, founder and president of Phoenix-based Ponaman Healthcare Consulting, an 18-person firm that specializes in 340B strategies. CAN has retained Ponaman for consulting work, and the firm has also worked with Baptist Health in Jacksonville and Jackson Health System in Miami. “Rick and his team at CAN have (used 340B) to grow more rapidly than most other organizations that do this in country.”

Threats remain

Carlisle and other CAN officials knew about 340B from industry contacts and fellow HIV and AIDS care providers with the Ryan White HIV/AIDS Program. Ryan White officials encouraged CAN to pursue 340B in 2015, right before Carlisle was named CEO. “We started out slow,” says Carlisle. “We were kind of scared, frankly.”

The deliberate speed, he adds, stems from worry over punishments for abusing the program, which, even without malice, can be stiff. “The penalties could wipe us out,” says Carlisle.

That’s why Carlisle has a big focus on 340B compliance. That includes Ponaman and a 340B attorney in Washington, D.C. In-house CAN analysts also pore through every CAN pharmaceutical record to make sure 340B rules are followed. The organization, says Carlisle, has passed all four of its federal audits with 100% scores. Says Carlisle: “I built the team up so compliance was priority No. 1.”

Air Florida

Not many nonprofits can afford to have a private plane.

But for Rick Carlisle, president and CEO at Sarasota-based CAN Community Health, the opposite is true: CAN, with facilities statewide and in South Carolina and Puerto Rico coming soon, in addition to an aggressive expansion plan, can’t afford to not have a private plane. “People say, ‘Isn’t that ridiculous to have your own plane,’” Carlisle says “But it’s not. This makes things really efficient for us.”

CAN analyzed the cost of drive time from its headquarters to clinics and future locations statewide, plus hotel and other costs. Some trips require multiple CAN officials, so efficiency is in play, too. It balanced that against the cost of a plane — a $2 million, eight-seat King Air plane. The plane won.

CAN keeps its plane at Dolphin Aviation in Sarasota, and its licensed on-call pilot is Matt Jensen, also the organization’s director of logistics. Now organization officials travel all over the Southeast for meetings, starting and ending their day in Sarasota. “This isn’t just an executive plane,” says Carlisle. “It’s for staff going to other clinics, too.”

The flip side is 340B, while it’s CAN’s lifeblood, is also Carlisle’s biggest worry. Pharmaceutical industry lobbyists, particularly in the past few years, say Carlisle and Ponaman, have begun to target 340B as government overreach. “Pharmaceutical companies see this as an adverse hit to their bottom line,” says Ponaman, and efforts are afoot to gut it, or at a minimum, curtail it.

Carlisle is aware, but pragmatic, toward the threat. Says Carlisle: “Anyone who wants to stop the model of how we do business is a worry.”

In the meantime, CAN’s mission remains the same: to keep finding places to provide more services and drive more awareness.

The organization made a splash in the Sarasota market recently, when it named Roger Capote chief advancement officer. Capote, previously senior director of special projects at Marie Selby Botanical Gardens in Sarasota and a prominent figure in the local charity circuit, will help further develop CAN’s brand and awareness. “Roger’s passion to our community and caring for people is paramount to this position,” Carlisle says in a statement.

Jifunza says he expects more hires like that in the future from CAN, and lots more expansion. “This isn’t it,” he says. “Even with all the growth CAN has had recently, you have not seen the half of it.”